Read this Medication Guide before you start taking STELARA™ and each time before you get an injection. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment with STELARA™.

What is the most important information I should know about STELARA™?

STELARA™ is a medicine that affects your immune system. STELARA™ can increase your chances of having serious side effects, including:

Serious Infections: STELARA™ may lower the ability of your immune system to fight infections and may increase your risk of infections. Some people have serious infections while taking STELARA™, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses. Some people have to be hospitalized for treatment of their infection.

• Your doctor should check you for TB before starting STELARA™.
• If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with STELARA™ and during treatment with STELARA™.
• Your doctor should watch you closely for signs and symptoms of TB during treatment with STELARA™.

You should not start taking STELARA™ if you have any kind of infection unless your doctor says it is okay.

Before starting STELARA™, tell your doctor if you think you have an infection or have symptoms of an infection such as:

• fever, sweats, or chills
• muscle aches
• cough
• shortness of breath
• blood in your phlegm
• weight loss
• warm, red, or painful skin or sores on your body
• diarrhea or stomach pain
• burning when you urinate or urinate more often than normal
• feel very tired
• are being treated for an infection
• get a lot of infections or have infections that keep coming back
• have TB, or have been in close contact with someone who has TB.

After starting STELARA™, call your doctor right away if you have any symptoms of an infection (see above).

STELARA™ can make you more likely to get infections or make an infection that you have worse.

People who have a genetic problem where the body does not make any of the proteins interleukin 12 (IL-12) and interleukin 23 (IL-23) are at a higher risk for certain serious infections. These infections can spread throughout the body and cause death. It is not known if people who take STELARA™ will get any of these infections, because of the effects of STELARA™ on these proteins in your body.

Cancers:

STELARA™ may decrease the activity of your immune system and increase your risk for certain types of cancers. Tell your doctor if you have ever had any type of cancer.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS):

RPLS is a rare condition that affects the brain and can cause death. The cause of RPLS is not known. If RPLS is found early and treated, most people recover. Tell your doctor right away if you have any new or worsening medical problems including:

• headache
• seizures
• confusion
• vision problems

What is STELARA™?

STELARA™ is a prescription medicine used to treat adults 18 years and older with moderate or severe psoriasis that involves large areas or many areas of their body, who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

STELARA™ may improve your psoriasis but may also lower the ability of your immune system to fight infections. This may also increase your risk for certain types of cancer.

It is not known if STELARA™ is safe and effective in children.

It is not known if taking STELARA™ for more than 2 years is safe and effective.

What should I tell my doctor before receiving STELARA™?

Before receiving STELARA™, tell your doctor if you:

• have any of the conditions or symptoms listed in the section “What is the most important information I should know about STELARA™?”
• have recently received or are scheduled to receive an immunization (vaccine). People who take STELARA™ should not receive live vaccines. Tell your doctor if anyone in your house needs a vaccine. The viruses used in some types of vaccines can spread to people with a weakened immune system, and can cause serious problems. You should not receive the BCG vaccine during the one year before taking STELARA™ or one year after you stop taking STELARA™.
• receive phototherapy for your psoriasis.
• have any other medical conditions.
• are pregnant or planning to become pregnant. It is not known if STELARA™ will harm your unborn baby. You and your doctor should decide if you will take STELARA™.
• are breast-feeding or plan to breast-feed. It is thought that STELARA™ passes into your breast milk. You should not breast-feed while taking STELARA™ without first talking with your doctor.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• other medicines that affect your immune system.
• certain medicines that can affect how your liver breaks down other medicines.

Ask your doctor or pharmacist if you are not sure if your medicine is one that is listed above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

How will I receive STELARA™?

• STELARA™ is given by injection under the skin (subcutaneous injection).
• STELARA™ should only be given by a healthcare provider as directed by your doctor.
• Your doctor will decide the right dose of STELARA™ for you and how often you should receive it.
• Be sure to keep all of your scheduled follow-up appointments.

What should I avoid while receiving STELARA™?

You should not receive a live vaccine while taking STELARA™. See “What should I tell my doctor before taking STELARA™?”

What are the possible side effects of STELARA™?

STELARA™ can increase your chances of having serious side effects. See “What is the most important information I should know about STELARA™?”

Common side effects of STELARA™ include:

• upper respiratory infections
• headache
• tiredness

These are not all of the possible side effects of STELARA™. Tell your doctor about any side effect that bothers you or that does not go away. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about STELARA™

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide.

This Medication Guide summarizes the most important information about STELARA™. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about STELARA™ that was written for healthcare professionals. For more information, go to www.STELARAinfo.com or call 1-800-457-6399.

What are the ingredients in STELARA™?

Active ingredient: ustekinumab

Inactive ingredients: sucrose, L-histidine, and polysorbate 80.

Manufactured by Cilag AG, Schaffhausen, Switzerland for Centocor Ortho Biotech Inc. Horsham, PA 19044

Revised September 2009

This Medication Guide has been approved by the U.S. Food and Drug Administration.

U.S. License No. 1821

Source:medicinenet.com

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators think the 2009 swine flu strain, first seen in Mexico, should be termed novel H1N1 flu since it is mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1). Recent investigations show the eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

Why is swine flu (H1N1) now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus’ antigenic makeup over time (usually years).

Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a “mixing pot” for flu RNA segments (see Figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

Figure 1. What are the symptoms of swine flu (H1N1)? Symptoms of swine flu are similar to most influenza infections: fever (100F or greater), cough, nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients also get nausea, vomiting, and diarrhea. In Mexico, many of the patients are young adults, which made some investigators speculate that a strong immune response may cause some collateral tissue damage. Some patients develop severe respiratory symptoms and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. The usual mortality (death) rate for typical influenza A is about 0.1%, while the 1918 “Spanish flu” epidemic had an estimated mortality rate ranging from 2%-20%. Swine flu in Mexico (as of April 2009) has had about 160 deaths and about 2,500 confirmed cases, which would correspond to a mortality rate of about 6%, but these initial data have been revised and the mortality rate currently in Mexico is estimated to be much lower. By June 2009, the virus had reached 74 different countries on every continent except Antarctica, and by September 2009, the virus had been reported in most countries in the world. Fortunately, the mortality rate as of October 2009 has been low but higher than for the conventional flu (average conventional flu mortality rate is about 36,000 per year; projected novel H1N1 flu mortality rate is 90,000 per year in the U.S. as determined by the president’s advisory committee). How is swine flu (H1N1) diagnosed? Swine flu is presumptively diagnosed clinically by the patient’s history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu (H1N1). If it is positive for type A, the person could have a conventional flu strain or swine flu (H1N1). However, the accuracy of these tests has been challenged, and the U.S. Centers for Disease Control and Prevention (CDC) has not completed their comparative studies of these tests. However, a new test developed by the CDC and a commercial company reportedly can detect H1N1 reliably in about one hour; as of October 2009, the test is only available to the military. Swine flu (H1N1) is definitively diagnosed by identifying the particular antigens associated with the virus type. In general, this test is done in a specialized laboratory and is not done by many doctors’ offices or hospital laboratories. However, doctors’ offices are able to send specimens to specialized laboratories if necessary. Because of the large number of novel H1N1 swine flu cases (as of October 2009, the vast majority of flu cases [about 99%] are due to novel H1N1 flu viruses), the CDC recommends only hospitalized patients’ flu virus strains be sent to reference labs to be identified. The CDC developed a PCR diagnostic test to detect novel H1N1 virus. Photo courtesy of the CDC

Source:medicinenet.com

BRAND NAME: Lovaza

DRUG CLASS AND MECHANISM: Lovaza is an antilipemic or fat-regulating drug that is used in addition to diet to reduce triglyceride (TG, a fat-carrying particle in the blood) levels in adult patients with severe elevations in blood levels of TG (≥mg/dL). TG is composed of three fatty acids as well as glycerol, and like cholesterol, comes from either the diet or the liver. High levels of TG in the blood are associated with conditions such as obesity, insulin resistance, poorly controlled diabetes mellitus amongst others that contribute to the risk of atherosclerosis or hardening of the arteries (progressive build up of waxy plaque on the inside of blood vessels) which, in turn, is responsible for coronary artery disease (angina and heart attacks) and strokes.

The precise way in which Lovaza works is not clear; however, its proposed mechanism of action is by decreasing the amount of TG produced by the liver and increasing the removal of TG by the liver. Other drugs that reduce TG levels include fibric acids such as gemfibrozil (Lopid), nicotinic acids such as niacin (Nicobid, Nicolar, Slo-Niacin), and statins such as atorvastatin (Lipitor). Lovaza was FDA approved on November 10, 2004.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Capsules: 1 gm

STORAGE: Lovaza should be stored at 25 C (77 F) and not frozen.

PRESCRIBED FOR: Lovaza is indicated as an adjunct to diet to reduce TG levels in adult patients with severe elevations of TG (≥ 500 mg/dL). Off-label uses of Lovaza include prevention of atherosclerosis and prevention of angina, heart attacks, and strokes.

DOSING: The daily dose of Lovaza is 4 grams per day. The daily dose may be taken as a single 4 gram dose (four capsules) or as two, 2 gram doses (two capsules given twice daily). Patients should be advised to swallow Lovaza capsules whole. They should not break open, crush, dissolve, or chew Lovaza capsules.

DRUG INTERACTIONS: Taking Lovaza with an anticoagulant (blood thinner) affecting coagulation such as aspirin, nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen (Motrin), warfarin (Coumadin), and heparin (Hep-Lock U/P) should be monitored periodically as Lovaza may increase the risk of bleeding.

Since some drugs may increase TG levels, patients should tell their doctor or pharmacist of the following medications before using Lovaza since their doctor may want to change the doses of these medications or monitor their effects; beta-blockers such as atenolol (Tenormin), diuretics or water pills such as hydrochlorothiazide (Diuril), and vitamins/supplements (fish/flaxseed/cod liver oils).

Lovaza contains ethyl esters of omega-3 fatty acids which are obtained from the oil of several fish sources. Lovaza should therefore be used with caution in patients with known sensitivity or allergy to fish and/or shellfish.

PREGNANCY: There are no adequate and well-controlled studies in pregnant women. Lovaza should be used during pregnancy only if the potential benefit to the patient justifies the potential risk to the fetus.

NURSING MOTHERS: It is not known whether Lovaza is excreted in human milk and caution should be exercised when administering Lovaza to nursing women.

SIDE EFFECTS: Upset stomach, burping, and strange tastes in may occur. If these effects persist or worsen, patients should notify their doctor. They also should tell their doctors immediately if any of the following rare but serious side effects that suggest increased bleeding occur: easy bleeding from cuts/bruising, black/tarry stools, vomitus that looks like coffee grounds.

Source:medicinenet.com

Pain is the most common reason for people to seek medical advice, pain medicine is the most frequently purchased over-the-counter (OTC) medication. Fever is one of the most common reasons that children visit the doctor. Moreover, one in five emergency room visits for children is due to fever. Since OTC medicines that are effective in treating pain also are effective at reducing fever, they will be considered together in this article.

What are the classifications of pain?

Pain can be classified as acute, chronic non-malignant, chronic malignant. Headaches are the most common cause of pain and can be considered a separate class of pain.

Acute pain

Acute pain is experienced by everyone; it is usually short in duration with an identifiable pathology, a predictable prognosis, and treatment that usually includes analgesics. Acute pain is most often due to injuries. Examples of injuries include:

• muscle soreness due to overuse, sprains or strains, or viral infections,
• tears of the ligaments,
• broken bones,
• bruises, and
• cuts.

Acute pain from such injuries can respond well to OTC pain medication. Muscle soreness also may respond well to heat and massage.

Chronic non-malignant pain

Chronic non-malignant pain often begins as acute pain, but it continues beyond the typical time expected for resolution of the problem or persists or recurs for other reasons. It is a type of pain associated with progressive, debilitating diseases such as arthritis. Treatment for chronic non-malignant pain can include OTC medications . However, because of the chronic nature of the pain, regular use of OTC medications can lead to side effects.

Chronic malignant pain

Chronic malignant pain is pain associated with advanced, progressive diseases (often fatal) such as cancer, multiple sclerosis, AIDS, and terminal kidney disease. OTC medications for pain may be useful for the management of chronic malignant pain. However, stronger prescription medications are usually necessary.

What are the types of headaches?

Headaches are the most common reason that pain medications (analgesics) are taken. Headaches can be classified into three types:

1. muscle contraction,
2. migraine or vascular, and
3. sinus.

Muscle contraction headache

A muscle contraction headache, the most common type, results from the continuous tightening of the muscles in the upper back, neck, or scalp. This type of headache often is described as a tight, pressing, or throbbing sensation of the head. It can be brought on by emotional stress and anxiety (“tension headaches”). Acute muscle contraction headaches generally respond well to OTC analgesics, but chronic muscle contraction headaches can require physical therapy or relaxation techniques

Source:medicinenet.com

Employment change. Employment of medical assistants is expected to grow 35 percent from 2006 to 2016, much faster than the average for all occupations. As the health care industry expands because of technological advances in medicine and the growth and aging of the population, there will be an increased need for all health care workers. Increasing use of medical assistants in the rapidly growing health care industry will further stimulate job growth.

Helping to drive job growth is the increasing number of group practices, clinics, and other health care facilities that need a high proportion of support personnel, particularly medical assistants who can handle both administrative and clinical duties. In addition, medical assistants work primarily in outpatient settings, a rapidly growing sector of the health care industry.

Job prospects. Job seekers who want to work as a medical assistant should find excellent job prospects. Medical assistants are projected to account for a very large number of new jobs, and many other opportunities will come from the need to replace workers leaving the occupation. Those with formal training or experience—particularly those with certification—should have the best job opportunities.

Source:bls.gov

Education and training. Postsecondary medical assisting programs are offered in vocational-technical high schools, postsecondary vocational schools, and community and junior colleges. Programs usually last either 1 year and result in a certificate or diploma, or 2 years and result in an associate degree. Courses cover anatomy, physiology, and medical terminology, as well as typing, transcription, recordkeeping, accounting, and insurance processing. Students learn laboratory techniques, clinical and diagnostic procedures, pharmaceutical principles, the administration of medications, and first aid. They study office practices, patient relations, medical law, and ethics. There are various organizations that accredit medical assisting programs. Accredited programs often include an internship that provides practical experience in physicians’ offices, hospitals, or other health care facilities.

Formal training in medical assisting, while generally preferred, is not always required. Some medical assistants are trained on the job, although this practice is less common than in the past. Applicants usually need a high school diploma or the equivalent. Recommended high school courses include mathematics, health, biology, typing, bookkeeping, computers, and office skills. Volunteer experience in the health care field also is helpful. Medical assistants who are trained on the job usually spend their first few months attending training sessions and working closely with more experienced workers.

Some States allow medical assistants to perform more advanced procedures, such as giving injections, after passing a test or taking a course.

Certification and other qualifications. Employers prefer to hire experienced workers or those who are certified. Although not required, certification indicates that a medical assistant meets certain standards of competence. There are various associations—some listed in the sources of information below—that award certification credentials to medical assistants, and the certification process varies. It also is possible to become certified in a specialty, such as podiatry, optometry, or ophthalmology.

Medical assistants deal with the public; therefore, they must be neat and well groomed and have a courteous, pleasant manner and they must be able to put patients at ease and explain physicians’ instructions. They must respect the confidential nature of medical information. Clinical duties require a reasonable level of manual dexterity and visual acuity.

Advancement. Medical assistants may advance to other occupations through experience or additional training. For example, some may go on to teach medical assisting, and others pursue additional education to become nurses or other health care workers. Administrative medical assistants may advance to office manager, or qualify for a variety of administrative support occupations.

Source:bls.gov

The duties of medical assistants vary from office to office, depending on the location and size of the practice and the practitioner’s specialty. In small practices, medical assistants usually do many different kinds of tasks, handling both administrative and clinical duties and reporting directly to an office manager, physician, or other health practitioner. Those in large practices tend to specialize in a particular area, under the supervision of department administrators.

Medical assistants who perform administrative tasks have many duties. They update and file patients’ medical records, fill out insurance forms, and arrange for hospital admissions and laboratory services. They also perform tasks less specific to medical settings, such as answering telephones, greeting patients, handling correspondence, scheduling appointments, and handling billing and bookkeeping.

For clinical medical assistants, duties vary according to what is allowed by State law. Some common tasks include taking medical histories and recording vital signs, explaining treatment procedures to patients, preparing patients for examinations, and assisting physicians during examinations. Medical assistants collect and prepare laboratory specimens and sometimes perform basic laboratory tests on the premises, dispose of contaminated supplies, and sterilize medical instruments. They might instruct patients about medications and special diets, prepare and administer medications as directed by a physician, authorize drug refills as directed, telephone prescriptions to a pharmacy, draw blood, prepare patients for x-rays, take electrocardiograms, remove sutures, and change dressings.

Medical assistants also may arrange examining room instruments and equipment, purchase and maintain supplies and equipment, and keep waiting and examining rooms neat and clean.

Ophthalmic medical assistants, optometric assistants, and podiatric medical assistants are examples of specialized assistants who have additional duties. Ophthalmic medical assistants help ophthalmologists provide eye care. They conduct diagnostic tests, measure and record vision, and test eye muscle function. They also show patients how to insert, remove, and care for contact lenses, and they apply eye dressings. Under the direction of the physician, ophthalmic medical assistants may administer eye medications. They also maintain optical and surgical instruments and may assist the ophthalmologist in surgery. Optometric assistants also help provide eye care, working with optometrists. They provide chair-side assistance, instruct patients about contact lens use and care, conduct preliminary tests on patients, and otherwise provide assistance while working directly with an optometrist. Podiatric medical assistants make castings of feet, expose and develop x rays, and assist podiatrists in surgery.

Work environment. Medical assistants work in well-lighted, clean environments. They constantly interact with other people and may have to handle several responsibilities at once. Most full-time medical assistants work a regular 40-hour week. However, many medical assistants work part time, evenings, or weekends.
Source:bls.gov

A highly talented Medical Assistant with huge experience in performing routing patient screening, additional technical supportive services, medical clerical duties and other duties, as assigned; collecting, handling, and processing patients’ laboratory specimens, including phlebotomy and performing routine in-house laboratory tests; administering medications to patients on specific orders from a provider.

Summary of Qualifications

* More than eight years experience as Medical Assistant.
* Great ability to effectively present information in one-on-one and small group situations to clients and other employees of the organization.
* Uncommon ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
* Strong ability to communicate effectively and clearly (both written and oral communication).
* Remarkable ability to interact effectively with other employees in all levels of the organization aswell as with the general public.
* Excellent basic clerical and computer skills.
* Ability to lift up to 40 pounds and push up to 200 pounds on wheels.
* Sound ability to hear staff on the phone and those who are served in person.
* Excellent vision which is necessary to read written materials, computer screens, registration forms and other clinic documents.
* Great manual dexterity; ability to reach above the shoulder level to work; bend, squat, sit, stand, stoop, crouch, reach, kneel, twist, and turn.
* Demonstrated ability to work in a busy clinic and multi-program environment.
* Uncommon ability to understand and relate to special health needs and problems of a diversified, low-income, communities.

Professional Experience

New York University Hospital, Tarrytown, NY
1997 – Present

Medical Assistant

* Interview patients, measure vital signs, such as pulse rate, temperature, blood pressure, weight, and height, and record information on patients’ charts.
* Prepare treatment rooms for examination of patients.
* Drape patients with covering and positions instruments and equipment.
* Hand instruments and materials to doctor as directed.
* Clean and sterilize instruments.
* Inventory and order medical supplies and materials.
* Operate x ray, electrocardiograph (EKG), and other equipment to administer routine diagnostic test or call medical facility or department to schedule patients for tests.
* Give injections or treatments, and perform routine laboratory tests.
* Schedule appointments, receive money for bills, keep x ray and other medical records, perform secretarial tasks, and complete insurance forms.
* Key data into computer to maintain office and patient records.
* Keep billing records, enter financial transactions into bookkeeping ledgers, and compute and mail monthly statements to patients.

Education and Professional Training

Current CPR Certification, Medication Aide Certification

High School Diploma in Nursing (1997)